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IMPLEMENTATION OF PATIENT SAFETY PROGRAM BY NURSE AT HOSPITAL “X” IN SAMARINDA AND
FACTORS INFLUENCE
Iwan M. Ramdan, Dina Lusiana S.
Department of Occupational Health and Safety, Public Health Faculty Mulawarman University, East Kalimantan, Indonesia
Email: [email protected]
Abstract
Background: Patient Safety is a system to prevent the occurrence of unexpected events due to actions taken or not even done by medical and non-medical personnel. Nurses are health workers, amounting at most and has a major role in the implementation of patient safety because the profession is to provide services for 24-hour nursing care. A cross-sectional descriptive study was performed on a total of 77 nurses in “X” Hospital. The objective of this study was determining the association between education level, work experience, perception of professionalism, knowledge and motivation with implementation of patient safety program.
Method: Data collection using a questionnaire and data anaysis using Chi Square test.
Results: The results indicated that work experience (p = 0.034), perception of professionalism (p = 0:03), knowledge of patient safety (p = 0.000) and motivation (p = 0.000) influence to the implementation of patient safety.There was no significant influence of educational level on the implementation of patient safety program (p = 0.427).
Conclusion: To improve the perception and knowledge, hospitals are advised to hold trainings related to patient safety regularly, and implement reward and funishment system to increase nurse motivation.
Keyword: level of education, work experience, perception of professionalism, knowledge motivation, patient safety
1. Introduction
Patient safety is a top priority in the implementation of health care is a shared responsibility across professions in health care and related to issues of quality and image of the hospital. Patient safety is a system to prevent the occurrence of unexpected events as a result of action taken was not even done by medical and non- medical personnel. The system includes risk assessment, identification and management of issues related to patient risk, reporting and analysis of incidents, the ability to learn from the incident and follow-up and implementation of solutions to minimize the risk.1
As a health worker in the hospital with the highest number (40-60%), nurses have job descriptions to implement patient safety that has a key role in determining the success of hospital patient safety program. The behavior of nurses in providing nursing care is preferred to ensure patient safety. Nurses have the longest contact time between other health workers as nurses provide nursing care for 24 hours.
According to WHO (2005) the chances of accidents in the hospital is 1: 300, is greater than the opportunity flights accidents in which only 1: 3.2 This shows that patient safety requires careful attention from all stake holders. Estimated more than 1.4 million people worldwide patients acquire infections from hospitals, the risk of acquiring infectious diseases in developing countries 2 to 20 times that of developed countries.
Results of research Institute of medicine (2000), in the United States concluded that of the 33.6 million patients are 44,000 to 98,000 people die from medical errors and
adverse medical events annually. While the publication suggested figures hospital research in various countries such as USA, UK, Denmark and Australia found unexpected events with a range of 3.2 to 16.6%.2 In Indonesia, the data on the incidence of unexpected event especially near misses are still hard to find, there are only the results of a survey conducted Ramsay Health Care Clinic Government in 2005 in the field of nursing in a private hospital, out of a total sample of 236 nursing staff, there are 57 people (24%) conduct drug administration errors.1
The behavior of nurses in the implementation of a program is influenced by internal factors as a particular stimulus, knowledge, and motivation, as well as factors beyond himself that organizational factors. Support organizations in health services, and other service sectors in improving the performance of employees one of which is determined by the atmosphere in the organization created by the system of relationships or communication (interpersonal relationships) that apply within the organization.3 The behavior of the nurse as the spearhead of health providers including the implementation of patient safety is a very important issue to be studied in order to maintain and improve the quality of health services. Good performance of health workers is a bridge in answering guarantee quality health care that is given to patients either sick or healthy. The key point in improving the quality of health care is the health workers who have high motivation
Hospital X is one private hospital in Samarinda in East Kalimantan has begun implementing patient safety program since 2011, but until now have not been evaluated. The objective of this study was determining the association. The objective of this study was determining the association between education level, work experience, perception of professionalism, knowledge and motivation with implementation of patient safety program.
2. Research Method
This study was an observational analytic with cross sectional design. The study population was all nurses who work in hospitals X which amounted to 77 people, in which all members of the study population sampled (total sampling). Data Collecting using questionnaires that have been tested sufficiently valid (correlation probability <
0.05) and reliable (reliability coefficient > 0.60). The independent variables consist of nurse education level, work experience, perception of professionalism, knowledge and motivation to work, while the dependent variable patient safety program implementation. Analysis of the data using the techique of chi square.
3. Results and Analysis A. Result
1. Characteristics of Respondents
Table 1. Characteristics of Respondents
Characteristic Number %
Gender Male 27 35.1
Female 50 64.9
Marital status Married 56 72.7
Not married 21 27.3
Level of education SPK 2 2.6
D3 67 87
S2 8 10.4
Work experience 0– 5 years 39 50.6
>5 - 10 years 18 23.3
>10 – 15 years 9 11.6
>15 - 28 years 11 14.2
Based on Table 1 it can be seen that most of the respondents were female nurses (64.9%), marital status, most of whom were married (72.2%), educational level of most of the graduate diploma 3 of nurses (87%) and work experience most of the 0 to 5 years (23.3%).
2. Univariate Analysis
Table 2. Result of Univariate Analysis
Variable Number %
Implementation of patient safety program
High 34 44.2
Low 43 55.8
Perception of profesionalism
High 40 51.9
Low 37 48.1
Knowledge High 50 64.9
Low 27 35.1
Motivation High 47 61
Low 30 39
Based on Table 2 it can be concluded that the implementation of patient safety by nurses still not maximized, mostly located on the lower level (55.8%). Perceptions of nursing professionalism mostly at the high category (51.9%), the level of knowledge about patient safety mostly high (64.9%) and work motivation mostly at a high level (61%).
3. Bivariate analysis
Tabel 3. Result of bivariate analysis
Correlation of variables Sig 2 tailed Conclusion Perception of profesionalism_Patient safety program 0.03 Significant correlation Level of education_Patient safety program 0.427 No Corelation Work experience_Patient safety program 0.034 Significant correlation Knowledge_Patient safety program 0.000 Significant correlation Motivation_Patient safety program 0.000 Significant correlation
Based on Table 3 it can be concluded that there was a relationship between the perception of nurse professionalism with impelementation of patient safety program (p=0.03), there was no colleration between nurse educational level with impelementation of patient safety program (p=0.427),there was no colleration between nurse working experinece with impelementation of patient safety program (p=0.034),there was colleration between nurse knowledge with impelementation of patient safety program (p=0.000) andthere was no colleration between nurse motivation with impelementation of patient safety program (p=0.000).
B. Discuss
The results showed the nurse's perception of the professionalism is quite good and shows the nurse realized that patient safety is an integral part of health care based on nursing science.While the results of statistical analysis as listed in Table 3 show thatperception of nursing professionalism associated with the implementation of patient safety program. The results are consistent with the opinion of3, that the behavior and performance of one's work is influenced by psychological factors, one of which is the perception of a person. Perceptions
about the professionalism of individuals will affect the process in making a decision, and the presence of a person's decision will be compelled to do an activity to achieve its objectives. With actions that are based on the perception of the professionalism, will cause a program to implement the behavior of a real Patients safety based on the ability of nurses. The results are consistent with research4 which concluded there was a relationship perception of professionalism nurse with patient safety program implementation in the Prof. Dr R Soeharso Hospital Surakarta.
Table 3 shows the level of education is not related to the implementation of patient safety program by nurses. These results are not in line with the opinions5 which states that the level of formal education the higher will result in an increase in expectations in terms of career and job gains and income as well as performance, and the opinion of6 which states that education is one of the basic human needs necessary for self-development. The higher the education level, the more easily they accept and develop knowledge and technology, thereby increasing productivity, which in turn will improve the welfare of the family. The results of this study are also not the same as research and7 which concluded there was a relationship between the level of education of nurses with the performance of nurses in public hospitals Boyolali.
Based on Table 3 shows that work experience related to the implementation of the program patien safety by nurses. The results are consistent with the opinion Harsiwi8 which states that the long time work is an individual experience that will determine the growth in employment and occupation. Growth in employment positions can be experienced by a learning process only if lived and experienced, and the expectation of the people concerned have developed increased working attitude towards the positive, have the skills (knowledge) work gets better and work skills that increase in quality and quantity. The results are consistent with research Faizin and Winarsih7 which concluded there was a relationship between nurses experience with the performance of nurses in public hospitals Boyolali.
Based on Table 3 shows that the knowledge of nurses associated with implementation of patien safety program. The results are consistent with the Health Belief Model theory which states that a person's level of knowledge is influenced by the environment through a process of information and experience.
After receiving information from the outside someone will remember the material to be learned. Knowledge and perception of a person is also closely related to a person's actions in meeting their needs. Therefore, further education is very important in order to increase nurses in acquiring knowledge8. Thus it can be explained that the higher the nurses knowledge about safety Patients program, the higher the expected nurses to understand the importance of safety program implementation Patients were given to patients who will then manifest the implementation of safety measures Patients program realized.
Based on Table 3 shows that the motivation of work associated with the implementation of the patien safety program by nurses. The results are consistent with the opinion Siagian9, Motivation is a natural impulse that is contained within the individual to behave support or not support the implementation of a program.
Motivation is an important determinant for the performance of the individual in which the increasing motivation of an individual then increased performance also performed. states that motivation is impetus for someone to provide the greatest possible contribution to the success of the organization to achieve its objectives.
Thus motivation contributed to the increase of the program. Patients safety in carrying out its duties and responsibilities. The results are consistent with research by Murdyastuti (2010) which concluded there was a relationship
motivation nurse with implementation of patient safety program in the Prof. Dr R Soeharso Hospital Surakarta4, and research Muhammad Nur et al (2013) concluded that there is a relationship of motivation and supervision of nurses with the implementation of patient safety in Universitas Hasanuddin Hospital Makassar.
4. Conclusion
Based on the results of the study and discussion it can be concluded that work experience (p = 0.034), perception of professionalism (p = 0.03), knowledge of patient safety (p = 0.000) and motivation (p = 0.000) influence to the implementation of patient safety.There was no significant influence of educational level on the implementation of patient safety program (p = 0.427). To improve the perception and knowledge, hospitals are advised to hold trainings related to patient safety regularly, and implement reward and funishment system to increase nurse motivation.
References
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2. World Health Organization, World Alliance for patient safety, global patent safety challenge 2005-2006. Celan care is Safer Care, Geneva, WHO, 2005.
3. Gibson JL, Ivancevich JM, Donelly Jr. Organizations behavior structure processes, United Sates of America, Van Hoffmann Press, 1997.
4. Murdyastuti S., Influence the Perception of professionalism, knowledge and motivation of nurses towards patients safety implementation in Prof. Dr. R Soeharso Hospital, Surakarta, Surakarta, Post Graduate Program UNS, 2010.
5. Ellitan L., Peran sumber daya dalam meningkatkan pengaruh tehnologi dalam produktivitas, Surabaya, Universitas Kristen PETRA, 2003.
6. M., Grossmann, Human Capital Model of the demand for health, Cambridge, National Bureau of Economic Research, 1999.
7. Faizin, Achmad, Winarsih, Relationship of educational level and work experience with the performance of nurse in Pandan Arang Boyolali Hospital, Berita Ilmu Keperawatan, vol/no:
1(3), pp. 137-142, 2008. ISSN 1979-2697.
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